Thyroidectomy, although rare, may be performed for patients with thyroid cancer, hyperthyroidism, and drug reactions to antithyroid agents; pregnant women who cannot be managed with drugs; patients who do not want radiation therapy; and patients with large goiters who do not respond to anti-thyroid drugs.
The two types of thyroidectomy include:
- Total thyroidectomy: The gland is removed completely. Usually done in the case of malignancy. Thyroid replacement therapy is necessary for life.
- Subtotal thyroidectomy: Up to five-sixths of the gland is removed when antithyroid drugs do not correct hyperthyroidism or RAI therapy is contraindicated.
Thyroidectomy requires meticulous postoperative nursing care to prevent complications. Nursing priorities will include managing hyperthyroid state preoperatively, relieving pain, providing information about the surgical procedure, prognosis, and treatment needs, and preventing complications.
- Acute Pain
- Risk for Impaired Airway Clearance
- Impaired Verbal Communication
- Risk for Injury
- Deficient Knowledge
Risk for Ineffective Airway Clearance
Risk for Ineffective Airway Clearance: At risk for the inability to clear secretions or obstructions from the respiratory tract to maintain a clear airway.
Risk factors may include
- Tracheal obstruction; swelling, bleeding, laryngeal spasms
Possibly evidenced by
- Not applicable. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred and nursing interventions are directed at prevention.
- Client will maintain a patent airway, with aspiration prevented.
|Monitor respiratory rate, depth, and work of breathing.||Respirations may remain somewhat rapid, but the development of respiratory distress is indicative of tracheal compression from edema or hemorrhage|
|Auscultate breath sounds, noting the presence of rhonchi.||Rhonchi may indicate airway obstruction and accumulation of copious thick secretions.|
|Assess for dyspnea, stridor, “crowing,” and cyanosis. Note quality of voice.||Indicators of tracheal obstruction and laryngeal spasm, requiring prompt evaluation and intervention.|
|Caution patient to avoid bending neck; support head with pillows.||Reduces the likelihood of tension on the surgical wound.|
|Assist with repositioning, deep breathing exercises, and/or coughing as indicated.||Maintains clear airway and ventilation. Although “routine” coughing is not encouraged and may be painful, it may be needed to clear secretions.|
|Suction mouth and trachea as indicated, noting color and characteristics of sputum.||Edema and pain may impair the patient’s ability to clear own airway.|
|Check dressing frequently, especially the posterior portion.||If bleeding occurs, the anterior dressing may appear dry because blood pools dependently.|
|Investigate reports of difficulty swallowing, drooling of oral secretions.||May indicate edema or sequestered bleeding in tissues surrounding the operative site.|
|Keep tracheostomy tray at the bedside.||Compromised airway may create a life-threatening situation requiring an emergency procedure.|
|Provide steam inhalation; humidify room air.||Reduces the discomfort of sore throat and tissue edema and promotes expectoration of secretions.|
|Assist with procedures: Tracheostomy, return to surgery.||May be necessary to maintain airway if obstructed by edema of glottis or hemorrhage. Returning to the operating room may require ligation of bleeding vessels.|
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